Similarities of Pneumonia Readmissions and COPD Readmissions

Adding COPD to the conditions being tracked for excess readmissions for fiscal year 2015 increased Centers for Medicare & Medicaid Services (CMS) penalties for many of Virginia’s hospitals. Looking back over the past two years, reducing readmissions from pneumonia, another lung disease, have been more difficult to manage than reducing readmission for heart failure and acute myocardial infarctions (see Table 1). Those trends beg the question: What makes patients with lung illnesses more difficult to keep out of the hospital? The first place to look is at the predictive models which identify the contributing strength of the diagnoses found in patients with COPD and pneumonia. Key similarities are heart and kidney disease alongside the presence of lung disease. The relative influence of each of the diagnoses on the likelihood of readmission is similar. Malnutrition can be secondary to all three, or the polypharmacy that occurs when lung, heart and kidney problems occur together. None of these issues can be cured and managing them requires post-discharge access to community health care services and comprehensive planning before discharge.  As reported in a previous Research Corner item, patients with three or more chronic conditions are at high risk for readmission. Readmitted pneumonia and COPD patients follow that pattern. (9/11/2015)

Table 1. Comparison of Readmission Rates 2013 to 2015